Amendment to the Individual Life Application Standards - Interstate ...

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Date: 7/28/08 As Recommended by the Product Standards Committee Highlighting reflects amended to the 2/28/07 Adopted Standard (i) (ii) Treated, examined or advised by a member of the medical profession; or Been advised by a member of the medical profession to get specified medical care which was not completed, such as any hospitalization, surgery or diagnostic test, except those tests related to the Human Immunodeficiency Virus (AIDS virus); For any “yes” answer, details may be requested such as: name, address and telephone number of the medical professional or facility providing treatment, examination or advice, diagnosis, date of diagnosis, dates of treatment; (i) (j) (k) Inpatient and Outpatient Treatment. Whether the proposed insured within a specified period of time (not to exceed 5 years), has been an inpatient or outpatient in a hospital, clinic or medical facility, or any similar entity. For any “yes” answer, details may be requested such as: name, address and telephone number of the place where treatment was provided, diagnosis, date of diagnosis, dates of treatment; Diagnostic Tests. Whether the proposed insured, within a specified period of time (not to exceed 5 years), has had diagnostic tests such as: an electrocardiogram (EKG) or X-ray, except those related to the Human Immunodeficiency Virus (AIDS virus). For any “yes” answer, details may be requested such as: name, address and telephone number of the place where the tests were performed, name, address and telephone number of medical professional or facility prescribing the tests, dates of the tests; or Inability To Work, Attend School, or Perform Normal Activities of Like Age and Gender. Whether the proposed insured, within a specified period of time (not to exceed 5 years) has been unable to work, attend school or perform the normal activities of like age and gender, or been confined at home. For any “yes” answer, details may be requested such as: explanation of inability or confinement; name, address and telephone number of medical professional or facility consulted; diagnosis; treatment prescribed; medications prescribed; date of onset and recovery. (2) The application may state that, in responding to any of the questions, the proposed insured need not include colds, minor viruses or minor injuries which prevented normal activities for a period less than a specified period of days (such as 5 days). (3) The application may include an additional details section where the proposed insured may provide the details to “yes” answers. The details shall include information such as: name of proposed insured; question number; name, addresses and telephone numbers of all medical providers; diagnosis; date of © IIPRC 18
Date: 7/28/08 As Recommended by the Product Standards Committee Highlighting reflects amended to the 2/28/07 Adopted Standard onset; dates of consultations, tests and treatment; date of surgery; medications prescribed; date of recovery. F. MEDICAL EXAM If the medical exam is considered part of or a continuation of the application and attached to the policy at issue, then the following standards apply: (1) The application may include a separate section for questions to be answered by the proposed insured and a report of a paramedical or medical exam conducted by a medical professional designated by the company. (2) For the questions to be answered by the proposed insured, these may include the same questions as those included in these standards for Proposed Insured, Tobacco Use, Personal Physician or Medical Facility, Prescribed Medication and Diet and Medical Questions. For “yes” answers, the same type of details requested in those sections may also be requested. The proposed insured will be required to sign the section of questions to confirm that they have read the answers as written before signing, that the answers are true and complete to their best knowledge and belief, and that there are no exceptions to any answers other than as written, or statements to similar effect. § 5 ADDITIONAL STANDARDS FOR FRATERNAL BENEFIT SOCIETIES A. GENERAL The application may include the following: (1) MEMBERSHIP The application may require the membership information a fraternal determines it needs to administer the insurance plan, such as membership status (new or existing), lodge number, term of membership, state of membership, etc. © IIPRC 19
Page 1 and 2: 1. Date Adopted: AMENDMENT TO INDIV
Page 3 and 4: Date: 7/28/08 As Recommended by the
Page 17: Date: 7/28/08 As Recommended by the
Page 25 and 26: Specific supplement which shall req
Page 27 and 28: (e) (f) Benefits, Pension or Compen
Page 29 and 30: inpatient or outpatient in a hospit

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